OBJECTIVE: To identify vulvar and hymenal characteristics associated with sexual abuse among female children between 3 and 8 years of age. STUDY DESIGN: Using a case-control study design, we examined and photographed the external genitalia of 192 prepubertal children with a history of penetration and 200 children who denied prior abuse. Bivariate analyses were conducted using chi-square, Fisher's exact test, and Student's t tests to assess differences in vulvar and hymenal features between groups.